Download MBBS Anatomy PPT 19 Scapular And Back Region Notes

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Limb to the Vertebral Column

Movements of Scapula

Movements of Scapula

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Movements of Scapula

Movements of Scapula

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Arranged in two layers

Layer 1st

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a. Trapezus

b. Latissimus dorsi

Layer 2nd

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a. Levator scapulae

b. Rhomboideus major

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and minor

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Trapezius

Origin

? Occipital bone(external occiptal

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protuberunce), superior nuchal

line, ligamentum nuchae, spine of

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seventh cervical vertebra, spines

of all thoracic vertebrae and their

supraspinous ligament

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Insertion

? Upper fibers into posterior border

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of lateral third of clavicle

? middle fibres- medial border of

acromion and upper lip of crest of

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spine

? lower fibers pass upward and

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laterally and insert on medial end

of spine of scapula

Trapezius

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Nerve Supply

? Spinal part of accessory nerve

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(motor) and ventral rami of C3

and 4 (sensory- proprioceptive)

Action

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? Upper fibers along with levator

scapulae elevate the scapula;

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? middle fibers with rhomboids

pull scapula medially (retracts);

? lower fibers pull medial border of

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scapula downward , so upper and

lower fibres acting together

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rotate scapula-glenoid cavity face

upward assisted by lower 5

digitations of serratus anterior

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Latissimus dorsi

Origin

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? Iliac crest, lumbar fascia, spines of

lower six thoracic vertebrae(T7-

T12), lower three or four ribs, and

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inferior angle of scapula (5)

Insertion

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? Floor of bicipital groove of

humerus (1)

Nerve Supply

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? Thoracodorsal nerve

? C6, 7, 8,

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Action

? Extends, adducts, and medially

rotates the arm (3)

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? Its called the climbing muscle

? Raising of the trunk above the arm

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Levator scapulae

Origin

? Transverse processes of first fourth cervical

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vertebrae (1)

Insertion

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? Medial border of scapula (1)

Nerve supply

? C3 and 4 and dorsal scapular nerve

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? C3, 4, 5

Action

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? Raises medial border of scapula


ligamentum nuchae

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The ligamentum nuchae is a

large median ligament

composed of tendons and

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fascia located between the

posterior muscles of the

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neck. It covers the spines of

C1 to C6 vertebrae. It is a

superior and posterior

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extension of the

supraspinous ligamen

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Rhomboid minor

Origin

? Ligamentum nuchae and

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spines of seventh cervical

and first thoracic vertebrae

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(3)

Insertion

? Medial border of scapula (1)

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Nerve supply

? Dorsal scapular nerve C4, 5

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Rhomboid major

Origin
? Second to fifth thoracic spines
Insertion

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? Medial border of scapula (1)

Nerve supply
? Dorsal scapular nerve C4, 5

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Action
? Retract scapula
? The rhomboids work collectively with the

levator scapulae muscles to elevate the

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medial border of the scapula, downwardly

rotating the scapula with respect to the

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glenohumeral joint.

Muscles Connecting the Scapula

to the Humerus

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Deltoid

Origin

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? Lateral third of clavicle, acromion, spine of

scapula

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Insertion

? Middle of lateral surface of shaft of humerus

Nerve supply

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? Axillary nerve C5, 6

Action

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? Middle fibers Abducts arm; anterior fibers flex

and medially rotate arm; posterior fibers

extend and laterally rotate arm

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? Abduction from 15-90 degrees

Intramuscular Injection

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Structures under cover of Deltoid

BONE- Upper part humerus, coracoid process
,greater tubercle, lesser tubercle Intertuberculus

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sulcus

Bursa- Subdeltoid , subacromial bursa
Muscles ? attached around shoulder joint

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Vessel- Ant and Post circumflex humeral vessel
Nerves- Axillary

Supraspinatus

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Origin

? Supraspinous fossa of scapula

Insertion

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? Greater tuberosity of

humerus; capsule of shoulder

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joint

Nerve supply

? Suprascapular nerve 5, 6

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Action

? Abducts arm and stabilizes

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shoulder joint

? Initiation of abduction 0-15

degrees

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Infraspinatus

Origin

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? Infraspinous fossa of scapula

Insertion

? Middle impression of greater

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tubercle of humerus; capsule

of shoulder joint

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Nerve supply

? Suprascapular nerve after

passing through spino-glenoid

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notch 5, 6

Action

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? Lateral y rotates arm and

stabilizes shoulder joint

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Teres major

Origin

? Lower third of lateral border of

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scapula

Insertion

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? Medial lip of bicipital groove of

humerus

Nerve supply

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? Lower subscapular nerve C6, 7

Action

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? Medially rotates and adducts arm

and stabilizes shoulder joint

Teres minor

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Origin

? Upper two thirds of lateral border

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of scapula

Insertion

? Greater tuberosity of humerus;

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capsule of shoulder joint

Nerve supply

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? Axillary nerve (C4), C5, 6

Action

? Laterally rotates arm and

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stabilizes shoulder joint

Subscapularis

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Origin

? Subscapular fossa

Insertion

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? Lesser tuberosity of humerus

Nerve supply

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? Upper and lower subscapular

nerves C5, 6, 7

Action

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? Medially rotates arm and stabilizes

shoulder joint

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Rotator Cuff

? The rotator cuff is the name

given to the tendons of the

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subscapularis, supraspinatus,

infraspinatus, and teres minor

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muscles

? are fused to the underlying

capsule of the shoulder joint

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? stabilizing the shoulder joint

? The cuff is deficient inferiorly,

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and this is a site of potential

weakness.

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Rotator Cuff

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Axillary Nerve

? The axil ary nerve arises from the

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posterior cord of the brachial

plexus (C5 and 6) in the axil a

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? It passes backward and enters

the quadrangular space with the

posterior circumflex humeral

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artery

? As the nerve passes through the

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space, it comes into close

relationship with the inferior

aspect of the capsule of the

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shoulder joint and with the

medial side of the surgical neck

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of the humerus

? It terminates by dividing into

anterior and posterior branches

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Axillary Nerve

? branches:

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? An articular branch to the

shoulder joint

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? An anterior terminal

branch, which winds

around the surgical neck

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of the humerus beneath

the deltoid muscle; it

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supplies the deltoid and

the skin that covers its

lower part.

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Axillary Nerve

? A posterior terminal branch, which gives off

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a branch to the teres minor muscle and a

few branches to the deltoid, then emerges

from the posterior border of the deltoid as

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the upper lateral cutaneous nerve of the

arm

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? The axillary nerve can be injured in

dislocations of the shoulder joint

Suprascapular nerve

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Arterial Anastomosis Around the

Shoulder Joint

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? The extreme mobility of the

shoulder joint may result in

kinking of the axillary artery

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and a temporary occlusion

of its lumen

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? To compensate for this, an

important arterial

anastomosis exists between

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the branches of the

subclavian artery and the

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axillary artery

? ensuring that an adequate

blood flow takes place into

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the upper limb irrespective

of the position of the arm

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Arterial Anastomosis Around the Shoulder Joint

Branches from the Subclavian Artery

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? The suprascapular artery, which is

distributed to the supraspinous and

infraspinous fossae of the scapula

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? The superficial or transverse cervical

artery, which gives off a deep branch that

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runs down the medial border of the

scapula

Branches from the Axil ary Artery

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? The subscapular artery and its circumflex

scapular branch supply the subscapular

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and infraspinous fossae of the scapula,

respectively.

? The anterior circumflex humeral artery

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? The posterior circumflex humeral artery

? Both the circumflex arteries form an

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anastomosing circle around the surgical

neck of the humerus

Triangle Of Auscultation

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Boundaries-

Below- Horizontal fibres

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of latissimus dorsi

Medially- lateral border

of trapezius

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Laterally- vertebral

border of scapula

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Floor ? 6th and 7th rib

Apex of lower lobe of

both lungs lie beneath

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this triangle

Scapular Fracture

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Is there any problem ?
MCQ

? Injury to which of the following nerve leads to

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winging of scapula

a) Long thoracic nerve
b) Thoracodorsal nerve

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c) Suprascapular nerve
d) Dorsal scapular nerve

MCQ

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? Which of the following group of muscle acts as

lateral rotator of shoulder joint

a) Teres minor and infraspinatus

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b) Teres minor and teres major
c) Supraspinatus and infraspinatus
d) Serratus anterior and rhomboids

MCQ

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? Which of the following group of muscle acts as

lateral rotator of shoulder joint

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a) Teres minor and infraspinatus
b) Teres minor and teres major
c) Supraspinatus and infraspinatus
d) Serratus anterior and rhomboids